CPT 21196 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 80 - Assistant surgeon • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21196 |
National average reimbursement for CPT 21196 by major payers:
$1,762.75
$1,939.21
$2,082.72
$2,423.27
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 21196 | ||||||
United | 21196 | $1100.00 | 1487014361 - GRIFFIN CENTER FOR PAIN AND SPINE | 473061907 - (GA) GRIFFIN CENTER FOR PAIN AND SPINE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2400.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $1647.00 | 1134177256 - SPRING CREEK SURGERY CENTER LLC | 810596887 - (AR) SPRING CREEK SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $1940.00 | 1952404550 - WEST PALM BEACH CHILDREN'S SURGERY CENTER, LLC | 650789191 - (FL) WEST PALM BEACH CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2680.00 | 1093079196 - MERCY HOSPITALS EAST COMMUNITIES, MERCY OUTPATIENTSURGERY CENTER WASHINGTON | 431066883 - (MO) MERCY HOSPITALS EAST COMMUNITIES | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $5249.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $3000.00 | 1952912552 - SURGERY CENTER OF NORTH CENTRAL OHIO LLC, THE SURGERY CENTER OF NORTH CENTRAL OHIO | 833986181 - (OH) THE SURGERY CENTER OF NORTH CENT | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2388.00 | 1457725392 - THE ENDOSCOPY CENTER OF QUEENS INC | 262427823 - (NY) THE ENDOSCOPY CENTER OF QUEENS INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2250.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2450.00 | 1245806876 - WICHITA UROLOGY SURGERY CENTER,LLC | 834482229 - (KS) WICHITA UROLOGY SURGERY CENTERLLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $1700.00 | 1326379967 - WEIR ASC, LLC, SOUTHWEST EYE SURGERY CENTER | 271659546 - (OK) WEIR ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $5433.00 | 1053574244 - SURGERY CENTER AT UNIVERSITY PARK, LLC, PREMIER SURGERY CENTER OF SARASOTA | 203757623 - (FL) SURGERY CENTER AT UNIVERSITY PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $2707.00 | 1124396544 - VALLEY PLASTIC SURGERY LLC, VALLEY PLASTIC SURGERY | 454030103 - (OR) VALLEY PLASTIC SURGERY LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $6506.00 | 1942617477 - CENTER FOR ENDOSCOPY LLC | 464958743 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21196 | $702.22 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 21196 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21196 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 21196 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 21193-CPT | High | Reconstruction Of Mandibular Rami, Horizontal, Vertical, C, Or L Osteotomy; Without Bone Graft -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21194-CPT | High | Reconstruction Of Mandibular Rami, Horizontal, Vertical, C, Or L Osteotomy; With Bone Graft -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21195-CPT | High | Reconstruction Of Mandibular Rami &/Or Body, Sagittal Split; Without Internal Rigid Fixation -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21196-CPT | High | Reconstruction Of Mandibular Rami &/Or Body, Sagittal Split; With Internal Rigid Fixation -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21196. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21196 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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